Idelalisib (ZYDELIG)

Collapse All

Send in Email Print Collapse All Expand All

Indication

Chronic lymphocytic leukemia

Dose

Chronic lymphocytic leukemia

Oral: 150mg twice daily continuously until disease progression or unacceptable toxicity
Given in combination with rituximab

Supplied

Available as 100 mg and 150 mg film-coated tablets. Tablets should NOT be crushed or broken. Store at room temperature.

Pharmacological Category

Phosphatidylinositol 3-Kinase Inhibitor

Administration

Take with or without food

Missed Dose

If a dose is missed, patients should be instructed to take it as soon as they can if it is within 6 hours of the missed dose. If it is over 6 hours since the missed dose, patients should skip the missed dose and resume with the next scheduled dose.

Adverse Effects

Common: Neutropenia, Diarrhea/colitis, ALT increase, AST increase, Rash.

Less Common: Intestinal perforation, Cutaneous reactions, Hepatotoxicity, Allergic reactions, Pneumonia and pneumonitis, Progressive multifocal leukoencephalopathy (PML).

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Monitoring Parameters

Baseline before treatment: CBC & differential, platelets, creatinine, bilirubin, ALT, Alkaline phosphatase, LDH, HBsAg, HBcoreAb, Hepatitis C, and CMV-DNA by PCR.

During treatment:

First 3 months: CBC & differential, Platelets, bilirubin, ALT, CMV-DNA by PCR every 2 weeks.
Month 4-6: CBC & differential, Platelets, bilirubin, ALT, CMV-DNA by PCR monthly.
Month 7 onward: CBC & differential, Platelets, bilirubin, ALT, CMV-DNA by PCR every 1 to 3 months, as clinically indicated.

Drug Interactions

This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.
Current drug interaction databases should be consulted for more information.

Clinical Pearls

Avoid in pregnancy and lactation.
Ensure patient is aware of appropriate diarrheal management and has adequate supply of loperamide before initiating therapy.
Ensure PJP prophylaxis is prescribed during treatment and for 2-6 months after treatment discontinuation.

References

BC Cancer. BC Cancer Drug Manual. Idelalisib. Vancouver, British Columbia: BC Cancer Agency. Available at: http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Idelalisib_monograph.pdf.Updated November 1, 2020. Accessed February 2, 2024.

Lexicomp. Idelalisib Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Available at: https://online-lexi-com.qe2a-proxy.mun.ca/lco/action/doc/retrieve/docid/patch_f/5268162?cesid=3lBVcvcRL4P&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Didelalisib%26t%3Dname%26acs%3Dtrue%26acq%3Didel. Updated January 24, 2024. Accessed February 2, 2024.

Cancer Care Ontario. Idelalisib Monograph. Drug Formulary. Toronto, Ontario: Cancer Care Ontario. Available at:https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/44401 . Updated June 2019. Accessed January 22, 2024.

Gilead Sciences Canada Inc. ZYDELIG® Product Monograph. Mississauga, Ontario. Updated August 18, 2020.